Healthcare Provider Details

I. General information

NPI: 1093632648
Provider Name (Legal Business Name): BOULEVARD SCRIPTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4415 QUEENS BLVD
SUNNYSIDE NY
11104-2405
US

IV. Provider business mailing address

4415 QUEENS BLVD
SUNNYSIDE NY
11104-2405
US

V. Phone/Fax

Practice location:
  • Phone: 718-255-1486
  • Fax: 718-255-1487
Mailing address:
  • Phone: 718-255-1486
  • Fax: 718-255-1487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRA COHEN
Title or Position: OWNER
Credential:
Phone: 718-255-1486